What psychology offers in pain management

Facing persistent pain can feel overwhelming. Whether it is pain following surgery, pain linked with a medical condition or pain that continues despite everything being done, it is more than a physical sensation. In our clinical psychology practice, we routinely support adults whose pain has become part of a wider pattern of distress, reduced activity, mood change and uncertainty. This post sets out what psychology can offer, what the evidence shows, and how referring clinicians can help clients engage with this work in partnership.

Understanding pain as more than a tissue problem

Modern pain science emphasises that pain is rarely only about tissue damage. It is shaped by biological, psychological and social factors that interact over time (Bolton & Gillett, 2023, Kovačević et al., 2024). Psychological processes such as pain-related worry, beliefs that pain always equals damage, avoidance of movement, low mood and disrupted sleep all influence how persistent pain develops and continues. For clinicians, this means assessment goes beyond scans or structural labels, and includes how the person is interpreting, responding to and living with pain.

What the evidence shows for psychological intervention

There is a substantial and growing body of research showing that psychological therapies add meaningful value for people living with chronic pain.

• Systematic reviews indicate that cognitive behavioural therapy, and CBT-informed multimodal programmes, can improve pain interference, disability and psychological distress in adults with chronic pain (Sanabria-Mazo et al., 2023).
• Narrative and systematic reviews highlight effective behavioural treatments for chronic low back pain, including CBT, mindfulness-based approaches and acceptance and commitment therapy, with pragmatic guidance on selecting treatments (Mauck et al., 2022).
• A randomised clinical trial of Pain Reprocessing Therapy for primary chronic back pain reported that 66 percent of participants receiving the intervention were pain-free or nearly pain-free after four weeks, with benefits largely maintained at one year (Ashar et al., 2022).
• A BMJ network meta-analysis found psychological interventions were most effective when delivered with physiotherapy care, for example structured exercise, for chronic non-specific low back pain (Ho et al., 2022).

Psychological approaches are not magic fixes, however they reduce distress, improve function and strengthen self-management. They work best as part of a coordinated plan across disciplines.

How therapy helps - key mechanisms

As clinical psychologists, we focus on how thoughts, emotions and behaviours interact with pain, then build skills that change the day-to-day experience.

• Beliefs and meaning around pain: Many people fear that pain always signals ongoing damage. Reframing this, learning that hurt does not always equal harm, can reduce fear and avoidance and support gradual re-engagement.
• Catastrophising and worry: Cycles of “this will never get better” or “if I move it will get worse” are common. We help clients notice and respond to these patterns with more balanced perspectives, which reduces distress and increases confidence.
• Behavioural engagement and pacing: Boom-and-bust patterns are typical. Therapy supports pacing, activity scheduling and behavioural rehearsal so clients rebuild meaningful routines at a sustainable pace.
• Mood, sleep and broader wellbeing: Depression, anxiety, poor sleep and stress amplify pain interference. Addressing these domains improves resilience, mood and daily functioning.
• Self-management and autonomy: Skills practice shifts the focus from what pain does to me, to what I can do despite pain. This restores choice, identity and participation.

What this means for referring clinicians and clients

For consultants and allied health professionals, the way we frame and coordinate care matters.

• Set expectations: Explain that therapy supports living well with pain, reducing distress and improving function. It complements medical and physical treatments.
• Collaborate: Psychological input sits alongside medicines, procedures and physiotherapy. It does not imply pain is all in the head, it recognises mind and body are linked.
• Encourage active engagement: The best results come when clients practice skills between sessions, try behavioural experiments and track progress.
• Focus on function: Agree goals such as returning to work, walking further, or reconnecting socially. Function-focused goals align with the evidence base.
• Integrate and review: With consent, share updates and review outcomes across pain, activity, mood, sleep and quality of life so the whole team stays aligned.

Thinking ahead - what to expect and measure

Monitor not only pain intensity but also interference with life, mood, sleep, activity levels and confidence to self-manage. Many meaningful gains show up in how people live with pain rather than in a single numeric score. Given generally moderate effect sizes, therapy is one important pillar in a broader plan. For many clients, changes in function, confidence and quality of life are significant and sustained.

Closing thoughts

Persistent pain poses biological, psychological and social challenges. Psychological therapy offers an evidence-based contribution that helps beliefs shift, reduces distress and supports a return to valued activity. We work in partnership with clients and referrers to integrate this into a coherent plan, so pain has less power over daily life.

References

Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carl, E., Gray, A., Kohn, N., Sistek, S., Younger, J., & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 79(1), 13-23. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784694
Bolton, D., & Gillett, G. (2023). A revitalised biopsychosocial model, core theory, research paradigms, and clinical implications. Integrative Psychological and Behavioral Science, 57, 1092-1112. https://pubmed.ncbi.nlm.nih.gov/37681273/
Open access version: https://pmc.ncbi.nlm.nih.gov/articles/PMC10755226/
Ho, E. K. Y., Ferreira, M. L., Pinheiro, M. B., Pozzobon, D., Lin, C.-W. C., Chenot, J.-F., McLachlan, A. J., Maher, C. G., & Traeger, A. C. (2022). Psychological interventions for chronic, non-specific low back pain: Systematic review with network meta-analysis. BMJ, 376, e067718. https://www.bmj.com/content/376/bmj-2021-067718
PubMed: https://pubmed.ncbi.nlm.nih.gov/35354560/
Mauck, M. C., Aylward, A. F., Barton, C. E., Birckhead, B., Carey, T., Dalton, D. M., Fields, A. J., Fritz, J., Hassett, A. L., Hoffmeyer, A., Jones, S. B., McLean, S. A., Mehling, W. E., O’Neill, C. W., Schneider, M. J., Williams, D. A., Zheng, P., & Wasan, A. D. (2022). Evidence-based interventions to treat chronic low back pain: Treatment selection for a personalised medicine approach. Pain Reports, 7(5), e1019. https://pubmed.ncbi.nlm.nih.gov/36203645/
Open access version: https://pmc.ncbi.nlm.nih.gov/articles/PMC9529058/
Kovačević, I., Pavić, J., Filipović, B., Ozimec Vulinec, Š., Ilić, B., & Petek, D. (2024). Integrated approach to chronic pain: The role of psychosocial factors and multidisciplinary treatment, a narrative review. International Journal of Environmental Research and Public Health, 21(9), 1135. https://www.mdpi.com/1660-4601/21/9/1135
PubMed: https://pubmed.ncbi.nlm.nih.gov/39338018/